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2013-14 Application Online materials are available at www.LeadershipSAISD.org/apply.

Using the online application will facilitate the review process and ensure that you all materials are submitted and reviewed in a timely manner. If you choose to complete a paper application, please print and complete this application then mail all forms to: Leadership SAISD P.O. Box 15552 San Antonio, TX 78212 All paper application must be postmarked no later than June 14, 2013. For more information regarding Leadership SAISD or the application process, please visit our website at www.leadershipsaisd.org.

Program Requirements
There are no specific educational or professional requirements to participate in Leadership SAISD. The only steadfast requirements of our participants are a commitment to Leadership SAISD's Core Values along with a commitment to the students and families of San Antonio and the San Antonio Independent School District. Core Values: Expectancy: All students can learn and it is a community's responsibility to ensure that they do. Setting and maintaining high expectations for everyone involved in education is foundational to improving student achievement and advancing the interests of our students. Teamwork: Lasting solutions are neither created nor implemented in isolation. Relationships based on mutual trust and support will be key to meaningfully impacting SAISD. Inquiry: The education landscape in San Antonio is complex and fluid. Effective solutions will require a commitment to acquiring new knowledge and experiences. Tenacity: San Antonio's education system can be daunting in its complexity. It will require a committed and persistent group of individuals to advocate for the best interests or our students and spur meaningful reform. Certification I have read and understand Leadership SAISD's Core Values and Program Requirements.

Personal Information
Last Name _______________________ First Name____________________

Date of Birth (MM/DD/YYYY) (__________/_________/__________) Address (number and street) ______________________________________________ City__________________________________ Daytime Phone Number (________) ____________ - ______________ Cell Phone Number (________) ____________ - ______________ Zip __________________

Leadership SAISD will only use this number for communication and scheduling purposes. Email Address ___________________________@_________________

I live or work in... Please indicate the member district in which you live. District 1 Brackenridge/Fox Tech Cluster District 2 - Sam Houston Cluster District 3 - Highlands Cluster District 4 - Burbank Cluster District 5 - Lanier Cluster District 6 - Edison Cluster District 7 - Jefferson Cluster In SAISD, but not sure about the district Outside of the SAISD

Do you have children? If yes, please indicate your children's age range. Yes No

Age Range (Youngest-Oldest) (____________ - ____________) Where do/did your children attend school? Within SAISD__ Public School outside of SAISD Private School__ I do not have children 

Please list the schools your children attend/have attended.

Are you a graduate of SAISD? If so, please list any schools that you attended, within the district.  Yes No

References
Reference #1 Full Name - ________________________________________________ Email Address - ____________________________@_______________ Phone Number (__________) _______________ - _________________ Briefly explain your relationship to reference #1.

Alternate Reference Full Name - __________________________________________

Email Address - ____________________________@_______________ Phone Number (__________) _______________ - _________________ Briefly explain your relationship to reference #2.

Employment Information
Current Company or Organization ___________________________________________________________ City, State - _________________________, ______________________ Role/Position - _____________________________________________ Starting Date (MM/YYYY) (____________/____________) Description - Please describe the duties and responsibilities of your current role or position.

Previous Company or Organization (if applicable) ___________________________________________________________ City, State - _________________________, ______________________ Role/Position - _____________________________________________ Starting Date (MM/YYYY) (____________/____________) Description - Please describe the duties and responsibilities of your current role or position.

Education Background
High School Attended - ___________________________________________________ City, State__ - ____________________________________, ______________________ Years Attended (Start-End) (______________________ - _____________________) Degree/Certification Conferred - ___________________________________________

College/University #1 - ___________________________________________________ City, State__ - ____________________________________, _____________________ Years Attended (Start-End) (_____________________ - _____________________) Degree/Certification Conferred - __________________________________________

College/University #2 - ___________________________________________________ City, State__ - _______________________________________, __________________ Years Attended (Start-End) (______________________ - _____________________)

Have you ever served in the United States' military? I__ f yes, please elaborate in the section below. Yes No

Military Service

Resume - If available, please attach a current resume or curriculum vitae (CV) to the end of your application.

Professional Activities
Briefly explain your involvement in any professional activities that have been important to your personal or professional development. If not applicable, please indicate by answering "N/A"

Volunteer Experience
Briefly explain your involvement in any volunteer activities that have been important to your personal or professional development. If not applicable, please indicate by answering "N/A".

Essay Questions
Please answer each essay question in 200 words or less. Please attach additional pages as necessary. 1. What do you consider to be your most significant demonstration of leadership and its impact? Briefly explain why you consider it to be significant.

2. Briefly explain your interest in San Antonio's public education system.

3. What do you consider to be the most significant issue facing the San Antonio Independent School District today? Briefly describe how you could help address this issue.

4. What do you hope to gain from participating in Leadership SAISD?

5. What will you contribute to the experience of other participants in Leadership SAISD?

Application Certification
I certify that all of information provided herein is, to the best of my knowledge, complete and accurate. I understand that providing false or misleading information is grounds for immediate disqualification from participating in this or future Leadership SAISD cohorts. I Agree

___________________________________ Signature

_____________________ Date

Leadership SAISD 2013-14 Application

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